Prevalence of pathological duodenogastric reflux and the relationship between duodenogastric and duodenogastrooesophageal reflux in chronic gastrooesophageal reflux disease.
The role of duodenogastric reflux in gastrooesophageal reflux disease is still controversial.


OBJECTIVE
(i) To determine the prevalence of pathological duodenogastric reflux (DGR) in gastrooesophageal reflux disease patients and (ii) to define the relationship between DGR and duodenogastrooesophageal reflux.


METHODS
We evaluated 92 patients referred for investigation of recurrent reflux symptoms after proton pump inhibitors (PPI) therapy. All the patients filled out symptom questionnaires and underwent endoscopy, oesophageal manometry and combined oesophagogastric pH and bilirubin monitoring.


RESULTS
Endoscopy divided the 92 patients into four groups (group I: 25 nonoesophagitis patients, group II: 26 patients with grade A-B oesophagitis, group III: 21 patients with grade C-D oesophagitis and group IV: 20 patients with Barrett's oesophagus. Twenty-four of the 92 patients (26%) showed pathological DGR. Abnormal oesophageal bilirubin exposure was observed in 62 of the 92 patients (67.4%). Of the 62 patients with abnormal oesophageal bilimetry, 15 (24.2%) patients simultaneously showed pathological DGR. The gastric bilirubin exposure in patients with abnormal oesophageal, Bilitec tests did not differ from that in patients with normal oesophageal bilimetry (P>0.05). A weak correlation between oesophageal and gastric bilirubin exposure, both expressed as a percentage of time, was found (r=0.28; P<0.01).


CONCLUSIONS
Pathological DGR is present in a little more than a quarter of patients with recurrent reflux and dyspeptic symptoms after PPI therapy. Excessive DGR is not a prerequisite for pathological oesophageal exposure to duodenal contents. Gastric bilirubin monitoring may be useful to choose the best surgical treatment for patients with reflux and dyspeptic symptoms refractory to PPI.
Brillantino
Antonio
A
VIII Department of General and Gastrointestinal Surgery, School of Medicine, Second University of Naples, Naples, Italy. Antonio_Brillantino@libero.it
Monaco
Luigi
L
Schettino
Michele
M
Torelli
Francesco
F
Izzo
Giuseppe
G
Cosenza
Angelo
A
Marano
Luigi
L
Di Martino
Natale
N
D001663:Bilirubin / Q000378:metabolism; D002908:Chronic Disease; D004383:Duodenogastric Reflux / Q000150:complications*; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D050782:Esophageal pH Monitoring; D004942:Esophagitis, Peptic / Q000209:etiology; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008365:Manometry / Q000379:methods; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011788:Quality of Life; D012008:Recurrence; D017211:Treatment Failure
D054328:Proton Pump Inhibitors; D001663:Bilirubin